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Ultrasound Therapy for Recurrent Noninfective Olecranon Bursitis: a Case Report

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Ultrasound Therapy for Recurrent Noninfective Olecranon Bursitis: a Case Report Case Report Ultrasound therapy for recurrent noninfective olecranon bursitis: A case report S. Aswinprakash, D. Jagadeesh, R. Arulmoli, Yuvaraj Maria Francis1, Kaviarasu Mahalingam2, Robert Francis Stanley3, Diwakar Aiyaloo4 Anatomy Unit, Faculty of Medicine, AIMST University, 2Physiotherapy Unit, Faculty of Allied Health Professions, AIMST University, 3Physiology Unit, Faculty of Medicine, AIMST University, 4Biochemistry Unit, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia, 1Department of Anatomy, Saveetha Medical College, Thandalam, Chennai, India Abstract Olecranon bursa is the commonly involved structure of the elbow joint in trauma of any mechanical cause or infections due to its subcutaneous position. The overall incidence may vary, but it is more common in males between 30 and 60 years. Various pharmaceutical and physiotherapeutic treatment options are available based on septic or nonseptic conditions. Mostly antibiotics and nonsteroidal anti-inflammatory drugs are widely used by physicians, whereas electrotherapy modalities are the choice of treatment by physiotherapists. Among which, ultrasound (US) therapy is found to be more convenient and effective in treating bursitis. As of the recent evidence available, US therapy is highly effective in treating olecranon bursitis. Keywords: Bursitis, elbow, olecranon, orthopedics, trauma, ultrasound therapy Address for correspondence: Mr. S. Aswinprakash, Lecturer, Anatomy Unit, Faculty of Medicine, AIMST University, Semeling Bedong, Kedah, Malaysia 01800. E‑mail: [email protected] INTRODUCTION is not certain; it typically affects men between the ages of 30 and 60 years.[8,9] Nearly two-thirds of cases were noninfectious Olecranon bursa is a thin fluid-filled sac located at the tip types,[10] and usually, it is a sterile inflammation that develops of the elbow joint.[1-3] This superficial bursa usually develops secondary to any acute, occupational, or recreational trauma, between 7 and 10 years of age.[4] The floor of the olecranon crystal deposition like gout, and systemic autoimmune bursa lies on the triceps tendon and olecranon, and the roof diseases such as rheumatoid arthritis and systemic lupus is loosely connected to the overlying skin of the elbow.[5] The erythematosus. Most cases of nonseptic bursitis are function is to prevent the friction between the olecranon posttraumatic or due to overuse injuries (repeated minor process and the subcutaneous tissues during both flexion and trauma due to sports) or direct trauma. This causes bleeding extension of the elbow joint.[6] The location of this bursa itself within the bursa or release of inflammatory substances. makes it more prone to any kind of trauma or infection. The term olecranon bursitis is represented using various terms In the conservative management, anti-inflammatory such as swollen elbow, student’s elbow, and Baker’s elbow.[7] and antibiotic medications were prescribed based on the severity. Adjunct to that, various modalities such as The clinical features are characterized by pain, swelling, and inflammation at the point of the elbow. The overall incidence This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to Access this article online remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Quick Response Code: Website: For reprints contact: [email protected] www.jpionline.org How to cite this article: Aswinprakash S, Jagadeesh D, Arulmoli R, DOI: Francis YM, Mahalingam K, Stanley RF, et al. Ultrasound therapy for 10.4103/jphi.JPHI_4_19 recurrent noninfective olecranon bursitis: A case report. Int J Pharma Investig 2018;8:205-9. © 2019 International Journal of Pharmaceutical Investigation | Published by Wolters Kluwer - Medknow 205 Aswinprakash, et al.: Ultrasound therapy for recurrent noninfective olecranon bursitis: A case report cryotherapy, taping techniques, compression, and optimal He was prescribed with nonsteroidal anti-inflammatory elbow positioning and padding have been done to promote drugs (NSAIDs) and analgesics by an orthopedic surgeon the healing. Aspiration, corticosteroid injection, and who attended him initially, with a follow-up of one month surgical drainage and excision are only considered in severe and no further significant improvement, aspirations and two and recurrent cases. corticosteroid injections were administered into his affected left olecranon bursa; adhesive bandage was applied over the Ultrasound (US) therapy is one of the electrotherapy point of the elbow without any immobilization of the joint. modalities used in physiotherapy for treating inflammatory This made a temporary resolution of the condition, but conditions,[11] in which electrical energy is converted into the swelling appeared in the posterior elbow after 2 weeks. acoustic energy by means of deformation of piezoelectric crystal present within the transducer. Therapeutic US Laboratory investigations were done, and the fluid culture administered over the tissues will be having thermal and turned to be negative and all markers were in the normal nonthermal effects. Thermal effects aid in pain relief, range. The patient refused for any further invasive surgical whereas nonthermal effects enhance cell repair.[12] The procedures and referred for the physiotherapy management physiological effects had been proved and commonly to New Life Hospital, Chennai. During the assessment, the used for the soft-tissue injuries and associated rheumatic physical examination of the left elbow point showed an complaints.[13] This case report presents a unique treatment average of 5.5 cm and bounded mass over the olecranon for recurrent noninfective olecranon bursitis using US process without any tenderness, redness, or warmth. therapy. After the failure of conservative management, Goniometric active and passive range of elbow flexion a patient with recurrent nonseptic olecranon bursitis was and extension in the affected elbow was normal (0°–120°). treated with US therapy and completely recovered. This The movements at the radioulnar joint (supination therapy provided a safe method without creating any and pronation) were normal. There was no abnormal discomfort for the patient. It could be considered as an neurological involvement. No spasm or wasting of the attractive treatment option for chronic nonseptic olecranon muscles was observed. bursitis. The radiographical findings revealed the soft-tissue CASE REPORT enlargement over the olecranon process without any kind of fracture or abnormal bony growth. Based on the overall A 22-year-old healthy man, who is a regular basket ballplayer, clinical status and the fixed condition, it was diagnosed presented the complaints with left posterior elbow swelling, as recurrent noninfective olecranon bursitis. The patient pain, and discomfort for nearly 6 months [Figure 1]. He expressed and preferred his interest in trying physiotherapy had a history of elbow trauma by hitting the point of the management using electrotherapy modality. The decision elbow directly against the concrete floor of the basketball was made with US therapy and informed the patient about court, as a result of falling during sports activity. The pain the procedure. tends to increase during rest at the affected elbow. He continued to play basketball and is able to do functional Chattanooga brand US machine with the transducer head activities with a lesser pain and discomfort. However, he size of 5 cm2 was used for treating this patient [Figure 2]. denied any paresthesia around the elbow or weakness. Figure 2: Therapeutic ultrasound with plugged in transducer and Figure 1: Olecranon bursitis of the left elbow coupling media 206 International Journal of Pharmaceutical Investigation | Volume 8 | Issue 4 | October-December 2018 Aswinprakash, et al.: Ultrasound therapy for recurrent noninfective olecranon bursitis: A case report Effective radiated area was selected around the tip of the whirlpool (40.6°C) raised the temperature 1.1°C; however, elbow at the site of swelling with their adjacent margins; at this same depth, 3-MHz US raised the temperature 4°C after sterilizing the treatment area, coupling media were in 4 min. Thermal effects of the US over the body tissues applied over the affected site and the transducer head. The cause an increase in circulation, reduction of muscle transducer was moved in a circular and longitudinal pattern spasm, and extensibility of collagen fibers.[17] In a study over the site of swelling and its boundaries. The frequency of of done by Dyson et al., nonthermal effects of the US 3 MHz in continuous mode with a ratio of 1:1 and intensity are the cavitation, in which the microstreaming causes of about 0.5–0.8 W/cm2 was employed. The duration of the increase in flow of surrounding fluid. This kind of the treatment was 5–10 min every other day. The patient effect will reduce the swelling. Nonthermal effects occur attended 14 sittings for the therapy with progressive changes, when pulsed US is applied. Nonthermal effects are useful and complete resolution was achieved grossly during the for decreasing edema and promoting cellular repair. The final stages of therapy. Posttreatment evaluations were above-said changes are the result of the chemical, biologic, done in a regular follow-up of 2 weeks, 1 month, 2 months, mechanical, and thermal effects of the
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